Prospective, Multicenter, Randomized, Crossover Clinical Trial Comparing the Safety and Effectiveness of Cooled Radiofrequency Ablation With Corticosteroid Injection in the Management of Knee Pain From Osteoarthritis

• Published in: Regional anesthesia and pain medicine Vol. 43; no. 1; pp. 84 - 91
• Main Authors: Davis, Tim, Loudermilk, Eric, DePalma, Michael, Hunter, Corey, Lindley, David, Patel, Nilesh, Choi, Daniel, Soloman, Marc, Gupta, Anita, Desai, Mehul, Buvanendran, Asokumar, Kapural, Leonardo
• Format: Journal Article
• Language: English
• Published: England Copyright by American Society of Regional Anesthesia and Pain Medicine 01.01.2018; BMJ Publishing Group LTD; Lippincott Williams & Wilkins
• Subjects: Ablation; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Aged; Analgesics - therapeutic use; Arthralgia - diagnosis; Arthralgia - etiology; Arthralgia - physiopathology; Arthralgia - therapy; Arthritis; Betamethasone - administration & dosage; Betamethasone - adverse effects; Catheter Ablation - adverse effects; Chronic and Interventional Pain: Original; Clinical trials; Combined Modality Therapy; Cross-Over Studies; Denervation - adverse effects; Denervation - methods; Female; Humans; Immunomodulators; Injection; Injections, Intra-Articular; Knee; Knee Joint - drug effects; Knee Joint - innervation; Knee Joint - surgery; Male; Methylprednisolone - administration & dosage; Methylprednisolone - adverse effects; Methylprednisolone - analogs & derivatives; Methylprednisolone Acetate; Middle Aged; Osteoarthritis; Osteoarthritis, Knee - complications; Osteoarthritis, Knee - diagnosis; Osteoarthritis, Knee - physiopathology; Osteoarthritis, Knee - therapy; Pain; Pain management; Pain Measurement; Prospective Studies; Quality of life; Regional anesthesia; Time Factors; Treatment Outcome; Triamcinolone Acetonide - administration & dosage; Triamcinolone Acetonide - adverse effects; United States
• DOI: 10.1097/AAP.0000000000000690
• ISSN: 1098-7339; 1532-8651

BACKGROUND AND OBJECTIVESOsteoarthritis (OA) of the knee affects the aging population and has an associated influence on the health care system. Rigorous studies evaluating radiofrequency ablation for OA-related knee pain are lacking. This study compared long-term clinical safety and effectiveness of cooled radiofrequency ablation (CRFA) with intra-articular steroid (IAS) injection in managing OA-related knee pain. METHODSThis is a prospective, multicenter, randomized trial with 151 subjects with chronic (≥6 months) knee pain that was unresponsive to conservative modalities. Knee pain (Numeric Rating Scale [NRS]), Oxford Knee Score, overall treatment effect (Global Perceived Effect), analgesic drug use, and adverse events were compared between CRFA and IAS cohorts at 1, 3, and 6 months after intervention. RESULTSThere were no differences in demographics between study groups. At 6 months, the CRFA group had more favorable outcomes in NRSpain reduction 50% or greater74.1% versus 16.2%, P < 0.0001 (25.9% and 83.8% of these study cohorts, respectively, were nonresponders). Mean NRS score reduction was 4.9 ± 2.4 versus 1.3 ± 2.2, P < 0.0001; mean Oxford Knee Score was 35.7 ± 8.8 vs 22.4 ± 8.5, P < 0.0001; mean improved Global Perceived Effect was 91.4% vs 23.9%, P < 0.0001; and mean change in nonopioid medication use was CRFA > IAS (P = 0.02). There were no procedure-related serious adverse events. CONCLUSIONSThis study demonstrates that CRFA is an effective long-term therapeutic option for managing pain and improving physical function and quality of life for patients with painful knee OA when compared with IAS injection.Clinical Trial RegistrationClinicalTrials.gov (NCT02343003).